Chapter 7 (Clinical Psychology) Completed

Harmful dysfunction

-A current theory -Jerome Wakefield -Considers both scientific data (dysfunction) and social context (harmful)

Before the DSM

-Abnormal behavior was recognized and studied in ancient civilizations -In 19th century, asylums in Europe and US arose -Around 1990, Emil Kraepelin put forth some of the first specific categories of mental illness -Some early categorical systems were for statistical/census purposes --In the mid 1990s the US Army and Veterans Administration developed their own early categorization system in an effort to facilitate the diagnosis and treatment of soldiers returning from World War II. This served as a precursor to the first DSM.

Who defines abnormality? Additional information

-Authors of DSM make official definitions of disorders -Leading researchers in psychopathology -Many of these authors have been psychiatrists (DSM published by American Psychiatric Association) --Medical model of psychopathology ---Categorical definitions with specific symptoms -Increasing cultural diversity among these authors in more recent editions of DSM **DSM task forces consist largely of leading researchers in various specialty areas within psychopathology who are selected for their scholarship and expertise in their respective fields. It is noteworthy that these task forces consist primarily of psychiatrists.

Future editions continue

-Current changes under consideration (cont.): --Changes to current disorder criteria **E.g., lower threshold for binging and purging in bulimia nervosa, removing bereavement exception from major depressive disorder --Elimination of some disorders, including some types of personality disorders

Future editions

-DSM-5 (planned release in 2013) -Current changes under consideration: --Addition of some provisional disorders as official diagnoses --Premenstrual dyshporic disorder, binge eating disorder, attenuated psychosis syndrome *****Premenstrual dysphoric disorder (see Box 7.3) Binge eating disorder (essentially the binging component of bulimia nervosa without the purging) Attenuated psychosis syndrome (a milder, less frequent version of schizophrenia-like symptoms such as hallucinations and delusions) Visit www.dsm5.org for more information on DSM-5.

Additional information

-DSM-IV was published in 1994 -DSM-IV-TR was published in 2000 --TR stands for "text revision" --Only text, not diagnostic criteria, differ between DSM-IV and DSM-IV-TR ---So, these two editions are essentially similar ***The disorders in DSM-IV and DSM-IV-TR are organized into 16 broad categories, with numerous specific disorders filling each category.

Criticism of the current DSM

-Despite advances (e.g., empiricism, diagnostic criteria), some have criticized the current DSM: -Breadth of coverage ---Too many disorders? Some not actually forms of mental illness? Too many people stigmatized? -Concept of mental illness becoming trivialized? --Controversial cutoffs ***How many symptoms should be necessary for a particular disorder? What constitutes "significant distress and impairment?" ---Cultural issues ***Some progress, but still dominated by non-minority authors and traditional Western values? ******Popular and professional language reflects the categorical approach: "Does my child have ADHD?"; "Some of my clients have bipolar disorder"; "Michael has obsessive-compulsive disorder."

Various theories suggested abnormality is defined

-Personal distress (In severe depression or panic disorder) -Deviance from cultural norms(as in many cases in schizophrenia) -Statistical infrequency (as in rare disorder such as dissociate fugue) -Impaired social functioning (As in phobia and in more dangerous way, antisocial personality disorder) -Others

Defining abnormality has been a primary task of clinical psychologist since the inception of the field

-What defines abnormality? -Who defines abnormality? -Why is the definition of abnormality important?

Multiaxial assessment

According to this system, a mental health professional can provide diagnostic information on each of five distinct axes. The psychiatric disorders were divided into Axis I (thought to be more episodic) -Axis II (thought to be more stable and long lasting) -Axis III and IV offered clinicians a place a list medical conditions and psychological/ environment problems, relevant to the mental health issues and hand -Axis V, known as the global assessment of functioning (gaf) scale- provided clinicians an opportunity to place the client on a 100 point continuum describing the overall level of functioning

DSM-IV

And all previous editions of the DSM have been published by the AMERICAN PSYCHIATRIC ASSOCIATION

DSM-I AND DSM-II

Contained three broad categories of disorders **Psychosis **Neuroses **Character disorders

Minor depressive disorder

Currently minor depressive disorder is not an official diagnostic category --Instead, it is listed as a PROVISIONAL DISORDER- in an appendix of the DSM-IV and DSM-IV-TR **Its criteria include the same list of nine possible symptoms and the same duration that major depressive disorder entails, but only two (rather than five) of the nine symptoms are required to qualify for the diagnosis

DSMI_ and DSM-II

DSM-I Published in 1952 DSM-II published in 1968 --Similar to each other, but different from later editions -- Not scientifically or empirically based **Based on clinical wisdom or leading psychiatrist -Psychoanalytic/ freudian influence -Contained three broad categories of disorders --Psychoses, neuroses, characters disorders -No specific criteria, just paragraphs with somewhat vague descriptions *Psychoses (Which contain todays schizophrenia) *Neuroses (Which would contain todays mood and anxiety disorders) *Characters disorders (Which would contain todays personality disorders)

ADDITIONAL INFORMATION ABOUT DSM

DSM-IV included significant cultural advances Text describing disorders often includes culturally specific information Culture-Bound Syndromes are listed Not official diagnostic categories, but experiences common in some cultural groups Outline for Cultural Formulation Helps clinicians appreciate impact of culture on symptoms

Alternate Directions in Diagnosis and Classification (cont.)

Dimensional approach "Shades of gray" rather than "black and white" Place clients' symptoms on a continuum rather than into discrete diagnostic categories Five-factor model of personality could provide the dimensions Neuroticism, extraversion, openness, conscientiousness, and agreeableness More difficult to efficiently communicate, but more thorough description of clients? May be better suited for some disorders (e.g., personality disorders) *************

DSM-IV

Each of the mental disorder is conceptualized as a clinical significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated with present distress (a painful symptom) or disability (impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability or an important loss of freedom

Emil Kraepelin

Labeled specific categories such as mani depressive psychosis, and dementia praecox -These and other contributions by Kraepelin have resulted in his reputation as a founding father of current diagnostic system -During the 1800 and 1900s the primary purpose of diagnosis categories was the collection of statistical and census data

Who created the DSM

Many people played a significant role but the MOST SIGNIFICANT were those on the TASK FORCE ON DSM-IV (American Association, 1994) --This group consisted largely of leading researchers in various specialty areas within PSYCHOPATHOLOGY, who were selected for their scholarship and expertise in their respective fields. --MEDICAL MODEL OF PSYCHOPATHOLOGY **Categorical definitions with specific symptoms ***Increasing cultural diversity among these authors in more recent editions of DSM

Abnormality

Mental disorders, psychiatric diagnosis or more broadly, psychopathology

DSM-II-R

Minor changes from DMSM-III was published in 1987

Labeling an experience as a disorder can affect professional and clients

Professionals --Facilitate research, awareness and treatment Clients --Demystify difficult experience -Feels like not the only one --Acknowledge significance of problem --Access treatment --Stigma damages self image --Legal consequences

Philippe Pinel

Proposed specific categories such as melancholia, mania, and dementria

DSM-III

Published in 1980 -Very different from DSM-I and DSM-II --More reliant on empirical data, less reliant on clinical responses --Specific criteria defined disorders -Atheoretical (no psychoanalytic/ freudian influences) -Multi-axial assesment -Much longer- included many more disorders

Additional information about harmful dysfunction

Should the commonality of a behavior affect the way we evaluate that behaviour? Widiger and Mullins-Sweat (2008) considered the issue and came to this conclusion: "Simply because a behavior pattern is valued, accepted, encouraged, or even statistically normative within a particular culture does not necessarily mean it is conducive to healthy psychological functioning" (p. 360).

Who defines abnormality?

They use disorders- as defined by the Diagnosis and Statistical Manual of Mental Disorders (DSM), the prevailing diagnostic guide for mental health professionals- every day as they perform assessment, offer therapy and design and execute research studies

DSM-IV

Was published in 1994 -It retains almost all the same diagnostic categories as well as the five axis diagnostic system -Several disorders were moved from axis III to axis I leaving only personality disorders and mental retardation on Axis II - all other disorders now appear on Axis I - Passive aggressive disorder -Bipolar the rest in page 157